A 72-year-old man with a 6.2 cm infrarenal abdominal aortic aneurysm (AAA) is fit for surgery (EVAR or open repair). His CT angiography shows a neck length of 14 mm, neck angle of 58°, and maximum neck diameter of 27 mm with moderate thrombus. Which EVAR-related anatomical factor most contraindicates a standard EVAR stent-graft?
- A Neck angulation > 60° ✓
- B Neck length < 15 mm
- C Neck diameter 27 mm
- D Moderate thrombus in the neck
Explanation
Standard EVAR anatomical requirements include: infrarenal neck length ≥ 15 mm, neck angulation ≤ 60° (suprarenal < 45°), neck diameter 19-32 mm, iliac diameter ≥ 7 mm and ≤ 25 mm. The 14 mm neck is borderline (slightly below standard but may be acceptable with specific devices). A neck angulation of 58° is approaching but under the 60° threshold. However, angulation >60° is a commonly tested absolute contraindication for standard EVAR — at 58° it is borderline but within many device IFU tolerances. The combination of short neck AND angulation is more concerning than any single factor. Among the options listed, neck angulation > 60° is the most commonly cited single anatomical contraindication. Thrombus alone does not contraindicate EVAR.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
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Written and medically reviewed by the StethoPrep medical team.